Bilateral mandibular subcondylar fractures contributing to airway obstruction.

Bilateral mandibular fracture contributing to airway obstruction is a well-understood phenomenon. This is typically described as a rather immediate or acute process. After trauma, the production of a "flail mandible" with concomitant loss of support of tongue muscles is thought to result in obstruction of the upper airway. An unusual case in which the bilateral mandibular fractures contributed to an airway obstruction 10 days after the initial trauma is described. The cause is explained and methods of prevention and treatment are presented.

Motorcycle crash injuries and costs: effect of a reenacted comprehensive helmet use law.

STUDY OBJECTIVES: To document the effect of a reenacted comprehensive helmet use law on injuries and fatalities. DESIGN: Retrospective before-and-after analysis. SETTING: Two urban counties representing 40% of Nebraska's population. PARTICIPANTS: Six hundred seventy-one patients reported as injured to the Nebraska Department of Roads in the period from one year before through one year after the reenactment on January 1, 1989. RESULTS: The helmet use law was temporally associated with a 26% decrease in the reported rate of motorcycle crashes in Nebraska compared with five other midwestern states. There were sharp declines in the number (and rates) of reported injured, hospital transports, hospital admissions, severe nonhead injuries, severe head injuries, and deaths. Serious head injuries (Abbreviated Injury Score, 3 or higher) decreased 22%. The percentage of injured motorcyclists with serious head injuries was significantly lower among the helmeted motorcyclists (5%) than among the unhelmeted cyclists (14%) for the two years combined. CONCLUSION: The reenactment of a helmet use law resulted in fewer crashes, fatalities, and severe head injuries.

ACS general surgeons participate in payment reform activities.

As reported in the Bulletin at various times over the past several years, the American College of Surgeons has frequently been called upon by federal agencies and commissions to provide clinical information and advice on issues that are associated with implementation of the Medicare physician payment system reforms mandated by the Omnibus Budget Reconciliation Act of 1989 (OBRA '89). In doing so, the College has often relied on the expertise of Fellows who are deeply committed both to the practice of general surgery and to the College. The purpose of this article is to provide a review of the College's participation in activities related to implementation of the Medicare reforms, as viewed by some of the general surgeons who shared in those efforts.

Training in advanced trauma life support.

The lack of a standardized method for the initial assessment of the trauma patient's condition and the skills to perform emergency lifesaving surgical techniques in rural Nebraska has led to the development of an Advanced Trauma Life Support (ATLS) course. There has been a direct correlation between the presentation of the course in several rural areas of Nebraska and the improved quality of trauma care apparent when the patients arrive at a definitive care hospital. The national development of a standardized ATLS course will improve the survival of trauma patients as has been experienced with the Advanced Cardiac Life Support course and cardiac patients.